July 9, 2001
Hypoglycemia
Question from Victoria, British Columbia, Canada:
My three and a half year old son, diagnosed with type 1 diabetes about six months ago, never has had any severe hypoglycemic reactions (although one time we recorded a blood sugar level of 2.1 mmol/L [38 mg/dl] and he was just acting slow), but like most parents of a young child with diabetes, I am concerned about hypoglycemia and the fact that no one has been able to answer me specifically when damage occurs with hypoglycemia. Is there a subtle damage to his brain anytime his blood sugar goes below 4.0 mmol/L [72 mg/dl] (because there is a restriction of glucose to his brain) or is there damage only when there are clear and visible symptoms (for example, passing out or having seizures)?
Answer:
Nobody is being evasive. The questions that you pose are entirely legitimate, but we don’t have definitive answers. There is no convincing evidence of long term sequelae of occasional mild hypoglycaemia — an inevitable consequence of good glycaemic control. However, it is obviously highly desirable to minimise this in the context of an acceptable hemoglobin A1c (the tightrope of diabetes management) and to avoid severe hypos if at all possible.
KJR
